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Call For A Rational Approach

Experts have responded to the European Respiratory Journal asking for a “rational approach” to vaping and tobacco harm reduction

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Experts have written to the European Respiratory Journal (ERS), challenging the ERS policy on vaping and tobacco harm reduction and calling for it to adopt a rational approach. The ERS has recently declared that tobacco harm reduction is a failing strategy and “lacks evidence to justify the approach”.

The letter was submitted to the ERS by Nicholas Hopkinson (Imperial College) and is co-signed by John Britton (UK Centre for Tobacco & Alcohol Studies), Jacob George (University of Edinburgh), Linda Bauld (University of Stirling), Sanjay Agrawal (University of Leicester), John Moxham (King’s College), Deborah Arnott (ASH), and Ann McNeill (King’s College).

The experts note: “The stated policy of the European Respiratory Society is to strive ‘constantly to promote strong and evidence-based policies to reduce the burden of tobacco related diseases’.”

They say: “In our view, the recent ERS Tobacco Control Committee statement on tobacco harm reduction [linked to at the bottom of the article], though well-intentioned, appears to be based on a number of false premises and draws its conclusions from a partial account of available data. It also presents a false dichotomy between the provision of ‘conventional’ tobacco control and harm reduction approaches. We therefore respond, in turn, to the seven arguments presented against the adoption of harm reduction in the Committee’s statement.”

To the ERS saying tobacco harm reduction strategies are based on incorrect claims that smokers cannot or will not quit smoking, the experts respond: “The strategy is in fact based on the need for additional measures to help the estimated 100 million smokers in the European Union who still have not quit. Europe has the highest smoking prevalence of all the WHO Regions and business as usual has so far failed to help these individuals. Smoking rates are significantly associated with economic disadvantage and ongoing failure to address this is a huge driver of health inequality.”

“We respectfully suggest that the Society reconsiders its position, so that we can focus on our shared goal to make smoking history”

As far as the “undocumented assumptions” about the efficacy of vaping, the experts cite a National Institute for Health and Care Excellence paper and the study by Hajek et al., “A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy” published in the New England Journal of Medicine.

Key messages for the ERS:

  • People smoke tobacco because of nicotine addiction, but the major harms come not from the nicotine but from toxic substances in the smoke
  • Pharmacotherapy (e.g. dual NRT or varenicline) combined with psychological support should be made available to all smokers to help them to quit and should be considered as the first line approach
  • E-cigarettes are an effective means to deliver nicotine, with a much lower risk of harm than continuing to smoke
  • People who choose to use e-cigarettes to cut down or quit smoking should be offered psychological support and access to smoking cessation services
  • People who choose to use e-cigarettes should be advised that they need to switch completely in order to derive substantial health benefits
  • People using e-cigarettes should be advised to try to quit them too in the long term, but not at the risk of relapsing to smoking
  • Never-smokers should avoid e-cigarettes
  • E-cigarettes should continue to be subject to restrictions on age of sale, on advertising and on the strength of e-liquids, as set out in the EU Tobacco Products Directive
  • Respiratory clinicians must continue to campaign for the full implementation of the WHO MPOWER strategy designed to assist implementation of the Framework Convention on Tobacco Control, as this is the most powerful tool to deliver a smokefree generation
  • Raise taxes on tobacco

The letter adds that expecting 100% tobacco quit rates is unreasonable: “Harm reduction strategies do not assume that all smokers will completely switch from tobacco cigarettes to alternative products, any more than does the medicinally licensed strategy of using nicotine replacement therapy to cut down on smoking.

“No credible commentator has argued that reduced harm products are harmless. By definition, harm reduction strategies are based on reducing rather than eliminating harm and the likelihood that there is some risk from their long-term use is explicitly acknowledged in statements on the subject.”

The experts summarise that the ERS’ “blanket opposition” to vaping is “misguided” and will “lead to a number of important consequences that are adverse to health”.


  • “A rational approach to e-cigarettes – challenging ERS policy on tobacco harm reduction”, by Britton, George, Bauld et al. – [link]
  • ERS: Quit Or Die, POTV – [link]
  • Twice As Good As NRT, POTV – [link]
  • Strong Response to Efficacy Study, POTV – [link]

Photo Credit:

Dave Cross avatar

Dave Cross

Journalist at POTV
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Dave is a freelance writer; with articles on music, motorbikes, football, pop-science, vaping and tobacco harm reduction in Sounds, Melody Maker, UBG, AWoL, Bike, When Saturday Comes, Vape News Magazine, and syndicated across the Johnston Press group. He was published in an anthology of “Greatest Football Writing”, but still believes this was a mistake. Dave contributes sketches to comedy shows and used to co-host a radio sketch show. He’s worked with numerous vape companies to develop content for their websites.

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